Common steroid structures

If there is no improvement within 12 to 24 hours, surgical intervention is warranted. Early surgical treatment should be considered if the patient is immunocompromised or has diabetes. 24 Surgical treatment involves proximal and distal tendon exposure, and careful insertion of a catheter or feeding tube into the tendon sheath with copious intraoperative irrigation. 1 , 4 , 15 , 24 , 25 Postoperatively, the catheter may be left in place for 24 hours to allow for further low-flow irrigation. One retrospective study 29 questioned the utility of postoperative irrigation and found no difference in outcome whether the catheter was left in or taken out. Parenteral antibiotic therapy should be continued for at least 48 hours. Comparable oral antibiotic therapy should then be instituted and continued for an additional five to 14 days on an outpatient basis. Physical and occupational therapy should be initiated to reduce long-term disability from scarring and contractures.

SOURCES:
Brigham and Women's Hospital: "Facts about Meningiomas."
Cleveland Clinic: "Benign Soft Tissue Tumors."
American Cancer Society: "Salivary Gland Cancer."
UCSF Medical Center: "Fibroids."
American Cancer Society: "What is a soft tissue sarcoma?"
Children's Hospital Boston: "Hemangioma."
American Academy of Family Physicians: "Lipomas."
American Brain Tumor Association: "Meningioma."
National Cancer Institute: "What You Need to Know About Moles and Dysplastic Nevi."
American Academy of Orthopaedic Surgeons: "Osteochondroma (Bone Tumor)."
Cleveland Clinic: "Benign Bone Tumors."
eMedicine: "Papilloma, Conjunctival: Treatment & Medication."

The needle is smaller in size than that used during a conventional epidural approach. The procedure is performed with the patient lying on their belly using fluoroscopic (real-time x-ray) guidance, which helps to prevent damage to the nerve root. A radiopaque dye is injected to enhance the fluoroscopic images and to confirm that the needle is properly placed (See Figure 2). This technique allows the glucocorticoid medicine to be placed closer to the irritated nerve root than using conventional interlaminar epidural approach. The exposure to radiation is minimal.

Guidelines from the American College of Rheumatology conditionally recommend the use of intra-articular corticosteroid injections for treatment of knee osteoarthritis. 51 The duration of pain relief is one to two weeks in most trials, with a few showing improvements lasting three to four weeks. 60 – 63 Research uniformly supports the safety of intra-articular corticosteroid injections for treatment of knee osteoarthritis; however, these studies are limited by lack of histologic data and poor long-term follow-up. 64 A Cochrane review found weak evidence for the use of corticosteroid injections for the treatment of knee rheumatoid arthritis. 52

Common steroid structures

common steroid structures

Guidelines from the American College of Rheumatology conditionally recommend the use of intra-articular corticosteroid injections for treatment of knee osteoarthritis. 51 The duration of pain relief is one to two weeks in most trials, with a few showing improvements lasting three to four weeks. 60 – 63 Research uniformly supports the safety of intra-articular corticosteroid injections for treatment of knee osteoarthritis; however, these studies are limited by lack of histologic data and poor long-term follow-up. 64 A Cochrane review found weak evidence for the use of corticosteroid injections for the treatment of knee rheumatoid arthritis. 52

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